1984, 09-26 Permit App: 00003101 Furnace*
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MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last)
(First) (M) Department Use Only
�) `Project No. 3 f-0 I,
2 Project Address (Not Mailing Address) c,‘ space Zip
3 City/Community State
(N.—..
Subdivision/Plat Name
0 re061-")N I ri.— 6F I37
4 Assessor Parcel No.
pF13•—(00�
Lot
I Black
16 Contras r Firm Name
art Address
17 Zip /� pp w
Cit
State
Phone 9•11,-94,1.Z.
18 Contact Person
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
41ra...) pro
Business
Address
9 Zip
City
State
Phone
( )
15 Describe Work:
New 0 Addition/Alteration
0
Replace/Repair
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
8 VENT: Fan(s):
EvapCooler(s):
Hood(s):
Duct(s)1:
Miscellaneous:
10 APPLIANCE:
Dryer(s):
I Range s):
Gas Log(8):
Wood Stove/
Solid Fuel:
Gas Water Heater(s):
• 11 UNIT HEATER(S): Wall Mount: Y N
I
Floor: Y N
Suspended: Y N
12 AIR HANDLING: 10,000 CFM or less:
More than 10,000 CFM:
If
13 REFRIG SYSTEM BTU: 1-100M:
100-500M:
500-1000M:
14 1000-1750M:
Other:
Pressure Vessel (cu. ft.):
15 COMPRESSOR/HP: Less than 3: 13-15:
15-30:
30-50:
50+:
16 GAS PIPING SYSTEM: Number of outlets:
17 HEATING SYSTEM: 1-100,000 BTU: /0
13
100,001 + BTU:
18 TYPE FUEL SOURCE: Electric 0 ; Gas X ; 011 0 ; Coal ❑ .; Wood 0 ; Solar 0
19 TYPE DISTRIBUTION: Forced Air Radiant 0 ; Heat Pump
1* Number of separate zones for any heating, A/C or air handling system.
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF k ) DATE APPLICATION el-
OWNER
OWNER OR 4i�.x_A�